Fractures and dislocations (peds): Difference between revisions
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== Clavicle & Shoulder | ==Clavicle & Shoulder== | ||
{| | {| class="wikitable" | ||
|- | |- | ||
| Clavicle | | [[Clavicle fracture (peds)|Clavicle fracture]] | ||
| | | | ||
treatment: Sling/swathe x3 weeks, no sports x3 weeks | |||
Consult ortho immediately for neurovascular compromise<br> | Consult ortho immediately for neurovascular compromise<br> | ||
|- | |- | ||
| Shoulder dislocation | | [[Shoulder dislocation]] | ||
| | | | ||
Usually anterior/inferior, always get axillary view film | Usually anterior/inferior, always get axillary view film | ||
treatment: Closed reduction, sling/swathe for several weeks with ortho outpatient follow up due to high risk of recurrence<br> | |||
If posterior dislocation or neurovascular compromise, consult ortho immediately<br> | If posterior dislocation or neurovascular compromise, consult ortho immediately<br> | ||
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|} | |} | ||
==Humerus== | |||
{| class="wikitable" | |||
== Humerus | |||
{| | |||
|- | |- | ||
| Proximal fracture | | [[Proximal humerus fracture]] | ||
| | | | ||
Generally can tolerate | Generally can tolerate >50° angulation | ||
'''Classification''' - using the Neer classification system to divide humerus into 4 parts:<br> | '''Classification''' - using the Neer classification system to divide humerus into 4 parts:<br> | ||
Line 51: | Line 34: | ||
*surgical neck | *surgical neck | ||
treatment: Sling and swathe for several weeks, ortho outpatient follow up in 3-5 days if | |||
'''<br>''' | '''<br>''' | ||
|- | |- | ||
| Shaft fracture | | Shaft fracture | ||
| | | | ||
Consider abuse of | Consider abuse of <3 years old | ||
Radial nerve palsy is common, resolved with treatment<br> | Radial nerve palsy is common, resolved with treatment<br> | ||
treatment: Older kids/adolescents - Hanging long arm cast, ortho outpatient follow up in 3-5 days | |||
Immediate ortho consult: Child >20° or adolescent >10° angulation and/or radial nerve injury | |||
|} | |} | ||
==Elbow== | |||
{| class="wikitable" | |||
{| | |||
|- | |- | ||
| Supracondylar fracture | | [[Supracondylar fracture]] | ||
| | | | ||
On XR - posterior and anterior fat pads, anterior humeral line (bisects mid 1/3 of capitellum) | On XR - posterior and anterior fat pads, anterior humeral line (bisects mid 1/3 of capitellum) | ||
Line 108: | Line 60: | ||
Radial/median/ulnar palsies generally resolve with reduction<br> | Radial/median/ulnar palsies generally resolve with reduction<br> | ||
treatment: Minimally displaced: long arm posterior splint with elbow at 90° and forearm protonated/neutral<br> | |||
Ortho | Ortho follow up in 3-5 days with immobilization for 3 weeks<br> | ||
Immediate ortho consult for more than minimal displacement or neurovascular compromise<br> | Immediate ortho consult for more than minimal displacement or neurovascular compromise<br> | ||
|- | |- | ||
| Lateral condylar | | Lateral condylar | ||
| Displace | | Displace >2 mm, requires ortho reduction<br> | ||
|- | |- | ||
| Medial epicondylar | | Medial epicondylar | ||
| | | | ||
Displaced: requires open reduction by ortho | Displaced: requires open reduction by ortho | ||
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|- | |- | ||
| Radial head and neck | | Radial head and neck | ||
| | | | ||
treatment: splint elbow 90° forearm pronated/neutrol, always follow up with ortho | |||
Immediate ortho consult for angulation | Immediate ortho consult for angulation >15°<br> | ||
|- | |- | ||
| Elbow dislocation | | [[Elbow dislocation]] | ||
| High risk of neurovascular injury, always consult ortho for reduction<br> | | High risk of neurovascular injury, always consult ortho for reduction<br> | ||
|- | |- | ||
| Radial head subluxation | | Radial head subluxation | ||
| | | | ||
AKA 'nursemaid's elbow' | AKA 'nursemaid's elbow' | ||
Child holds are pronated, slightly flexed | Child holds are pronated, slightly flexed | ||
treatment: reduce with supination and flexion, post reduction patient uses arm in 5-10 minutes<br> | |||
|} | |} | ||
==Forearm/Wrist== | |||
{| class="wikitable" | |||
{| | |||
|- | |- | ||
| Radius/ulna shaft | | Radius/ulna shaft | ||
| | | | ||
75% are distal third, isolated ulna very rare | 75% are distal third, isolated ulna very rare | ||
treatment: <10° sugar-tong splint, immediately consult ortho for >10° angulation<br> | |||
|- | |- | ||
| Monteggia fracture | | [[Monteggia fracture]] | ||
| | | | ||
Ulna fracture and radial head dislocation | Ulna fracture and radial head dislocation | ||
Always consult ortho immediately! | Always consult ortho immediately! | ||
|- | |- | ||
| Galeazzi fracture | | [[Galeazzi fracture]] | ||
| | | | ||
Radial shart disruption of distal radioulnar joint | Radial shart disruption of distal radioulnar joint | ||
Always consult ortho immediately! | Always consult ortho immediately! | ||
|- | |- | ||
| Distal radius/ulna | | Distal radius/ulna | ||
| | | | ||
Distal radius AKA Colles' fracture | Distal radius AKA Colles' fracture | ||
treatment: Splint and ortho follow up in 3-5 days | |||
*Torus: Volar/short arm | *Torus: Volar/short arm | ||
*Greenstick/complete: Long arm posterior or sugar-tong | *Greenstick/complete: Long arm posterior or sugar-tong | ||
Immediate ortho consult for angluation | Immediate ortho consult for angluation >10-15° | ||
|- | |- | ||
| Carpal bones | | Carpal bones | ||
| | | | ||
Fractures are rare | Fractures are rare | ||
If scaphoid injury even suspected, thumb spica/cast for at least 2 weeks | If scaphoid injury even suspected, thumb spica/cast for at least 2 weeks | ||
|} | |} | ||
==Hand/Fingers== | |||
{| class="wikitable" | |||
{| | |||
|- | |- | ||
| Metacarpal fracture | | [[Metacarpal fracture]] | ||
| | | | ||
treatment: Distal 5th (boxer's) if nondisplaced apply gutter splint with MCP joint at 70° | |||
Immediate ortho consult if | Immediate ortho consult if >30-40° angulation; closed reduction often needed | ||
|- | |- | ||
| Phalangeal dislocation | | [[Phalangeal finger dislocation]] | ||
| | | | ||
PIP/DIP - Reduce and buddy tape x3 weeks, if PIP consider digital block pre-reduction | PIP/DIP - Reduce and buddy tape x3 weeks, if PIP consider digital block pre-reduction | ||
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|- | |- | ||
| Phalangeal fracture | | [[Phalangeal finger fracture]] | ||
| | | | ||
Distal tuft crush injury - | Distal tuft crush injury - treatment: laceration closure | ||
Most other fractures - | Most other fractures - treatment: buddy tape | ||
|} | |} | ||
==Hip/Femur== | |||
== Hip/Femur | |||
{| | {| class="wikitable" | ||
|- | |- | ||
| Hip dislocation | | [[Hip dislocation]] | ||
| Closed reduction within 6 hours | | Closed reduction within 6 hours | ||
|- | |- | ||
| SCFE | | [[SCFE]] | ||
| 8-15yo M:F 2:1, associated with obesity, increased risk in blacks, | | 8-15yo M:F 2:1, associated with obesity, increased risk in blacks, patient complains of hip/knee pain | ||
|- | |- | ||
| Femoral shaft | | [[Femoral shaft fracture]] | ||
| | | | ||
Birth-2yo: Traction or immediate casting | Birth-2yo: Traction or immediate casting | ||
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|- | |- | ||
| Femoral neck | | [[Femoral neck fracture]] | ||
| Traction/splint with ortho consult for closed or open reduction | | Traction/splint with ortho consult for closed or open reduction | ||
|} | |} | ||
==Knee== | |||
== Knee | |||
{| | {| class="wikitable" | ||
|- | |- | ||
| Knee dislocation | | [[Knee dislocation]] | ||
| Immediate reduction recommended, arteriogram post reduction | | Immediate reduction recommended, arteriogram post reduction | ||
|- | |- | ||
| Patella fracture | | [[Patella fracture]] | ||
| | | | ||
Non-dislocated: cylindrical cast x4-6 weeks | Non-dislocated: cylindrical cast x4-6 weeks | ||
Displaced | Displaced >3-4mm: ORIF | ||
|- | |- | ||
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|} | |} | ||
==Tib/Fib== | |||
== Tib/Fib | |||
{| | {| class="wikitable" | ||
|- | |- | ||
| Proximal tibia | | [[Proximal tibia fracture]] | ||
| Early ortho consult especially if intra-articular | | Early ortho consult especially if intra-articular | ||
|- | |- | ||
| Tib/fib shaft | | Tib/fib shaft | ||
| Long leg posterior splint, ortho | | Long leg posterior splint, ortho follow up in 3-5 days | ||
|- | |- | ||
| Toddler's | | [[Toddler's fracture]] | ||
| | | | ||
Technically an oblique non displaced fracture of the distal tibia | Technically an oblique non displaced fracture of the distal tibia | ||
treatment: Posterior splint | |||
|} | |} | ||
==Ankle & Foot== | |||
== Ankle & | |||
{| | {| class="wikitable" | ||
|- | |- | ||
| Distal tibia/fibula fractures | | Distal tibia/fibula fractures | ||
| | | | ||
Non-displaced: bulky posterior splint and crutches with ortho | Non-displaced: bulky posterior splint and crutches with ortho follow up in 3-5 days | ||
Tilaux: Salter III of distal tibia, requires ORIF | Tilaux: Salter III of distal tibia, requires ORIF | ||
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Midfoot fractures are rare | Midfoot fractures are rare | ||
treatment: bulky posterior splint, crutches, ortho follow up in 3-5 days | |||
|- | |- | ||
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|} | |} | ||
==See Also== | |||
*[[Fractures]] | |||
== | |||
Cincinnati Children's Hospital "The Pocket" 2010-2011 | ==References== | ||
<references/> | |||
*Cincinnati Children's Hospital "The Pocket" 2010-2011 | |||
[[Category: | [[Category:Pediatrics]] | ||
[[Category:Orthopedics]] |
Revision as of 21:41, 23 January 2017
Clavicle & Shoulder
Clavicle fracture |
treatment: Sling/swathe x3 weeks, no sports x3 weeks Consult ortho immediately for neurovascular compromise |
Shoulder dislocation |
Usually anterior/inferior, always get axillary view film treatment: Closed reduction, sling/swathe for several weeks with ortho outpatient follow up due to high risk of recurrence If posterior dislocation or neurovascular compromise, consult ortho immediately |
Humerus
Proximal humerus fracture |
Generally can tolerate >50° angulation Classification - using the Neer classification system to divide humerus into 4 parts:
treatment: Sling and swathe for several weeks, ortho outpatient follow up in 3-5 days if
|
Shaft fracture |
Consider abuse of <3 years old Radial nerve palsy is common, resolved with treatment treatment: Older kids/adolescents - Hanging long arm cast, ortho outpatient follow up in 3-5 days Immediate ortho consult: Child >20° or adolescent >10° angulation and/or radial nerve injury |
Elbow
Supracondylar fracture |
On XR - posterior and anterior fat pads, anterior humeral line (bisects mid 1/3 of capitellum) Radial/median/ulnar palsies generally resolve with reduction treatment: Minimally displaced: long arm posterior splint with elbow at 90° and forearm protonated/neutral Ortho follow up in 3-5 days with immobilization for 3 weeks Immediate ortho consult for more than minimal displacement or neurovascular compromise |
Lateral condylar | Displace >2 mm, requires ortho reduction |
Medial epicondylar |
Displaced: requires open reduction by ortho Nondisplaced: posterior splint with forearm pronated |
Radial head and neck |
treatment: splint elbow 90° forearm pronated/neutrol, always follow up with ortho Immediate ortho consult for angulation >15° |
Elbow dislocation | High risk of neurovascular injury, always consult ortho for reduction |
Radial head subluxation |
AKA 'nursemaid's elbow' Child holds are pronated, slightly flexed treatment: reduce with supination and flexion, post reduction patient uses arm in 5-10 minutes |
Forearm/Wrist
Radius/ulna shaft |
75% are distal third, isolated ulna very rare treatment: <10° sugar-tong splint, immediately consult ortho for >10° angulation |
Monteggia fracture |
Ulna fracture and radial head dislocation Always consult ortho immediately! |
Galeazzi fracture |
Radial shart disruption of distal radioulnar joint Always consult ortho immediately! |
Distal radius/ulna |
Distal radius AKA Colles' fracture treatment: Splint and ortho follow up in 3-5 days
Immediate ortho consult for angluation >10-15° |
Carpal bones |
Fractures are rare If scaphoid injury even suspected, thumb spica/cast for at least 2 weeks |
Hand/Fingers
Metacarpal fracture |
treatment: Distal 5th (boxer's) if nondisplaced apply gutter splint with MCP joint at 70° Immediate ortho consult if >30-40° angulation; closed reduction often needed |
Phalangeal finger dislocation |
PIP/DIP - Reduce and buddy tape x3 weeks, if PIP consider digital block pre-reduction MCP - If initial reduction fails. consult hand surgeon (plastics) Refer gamekeeper's thump (avulsion of ulnar collateral ligament; requires thumb spica x3-6 weeks |
Phalangeal finger fracture |
Distal tuft crush injury - treatment: laceration closure Most other fractures - treatment: buddy tape |
Hip/Femur
Hip dislocation | Closed reduction within 6 hours |
SCFE | 8-15yo M:F 2:1, associated with obesity, increased risk in blacks, patient complains of hip/knee pain |
Femoral shaft fracture |
Birth-2yo: Traction or immediate casting 2-10yo: Ortho consult, traction with spica casting Adolescent: Stabilize with traction splint, consult ortho |
Femoral neck fracture | Traction/splint with ortho consult for closed or open reduction |
Knee
Knee dislocation | Immediate reduction recommended, arteriogram post reduction |
Patella fracture |
Non-dislocated: cylindrical cast x4-6 weeks Displaced >3-4mm: ORIF |
Patella dislocation | Closed reduction with knee immobilizer x4 weeks |
Tib/Fib
Proximal tibia fracture | Early ortho consult especially if intra-articular |
Tib/fib shaft | Long leg posterior splint, ortho follow up in 3-5 days |
Toddler's fracture |
Technically an oblique non displaced fracture of the distal tibia treatment: Posterior splint |
Ankle & Foot
Distal tibia/fibula fractures |
Non-displaced: bulky posterior splint and crutches with ortho follow up in 3-5 days Tilaux: Salter III of distal tibia, requires ORIF |
Mid/Hindfoot fractures |
Talus: pain with dorsiflexion Calcaneous: fall from a height Midfoot fractures are rare treatment: bulky posterior splint, crutches, ortho follow up in 3-5 days |
Metatarsal/phalangeal |
Base of 5th metatarsal: 'Jones fracture', high nonunion rate Non-displaced - bulky splint and crutches Phalanged: buddy tape, hard soled shoes Intra-articular: great toe and/or significant displacement requires pinning |
See Also
References
- Cincinnati Children's Hospital "The Pocket" 2010-2011